Congenital defects cause the great majority of cases of PV insufficiency or stenosis. The pulmonary valve (PV), located between the right ventricle and the pulmonary artery, opens upon contraction of the right ventricle to release oxygen-depleted blood from the right ventricle into the pulmonary artery for delivery to the lungs. Other mechanical complication of heart valve prosthesis ICD-10 codes not covered for indications listed in the CPB: Other specified complication of cardiac devices, implants and grafts Stenosis of cardiac devices, implants and grafts ICD-10 codes covered if selection criteria are met: Harmony Transcatheter Pulmonary Valve (TPV) System, SAPIEN S3 valve - no specific code HCPCS codes covered if selection criteria are met: Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed Table: CPT Codes / HCPCS Codes / ICD-10 Codes CodeĬPT codes covered if selection criteria are met: Treatment of individuals with dysfunctional non‐conduit, patch-repaired RVOT.Īetna considers transcatheter pulmonary valve implantation for other indications (e.g., individuals with a degenerated bioprosthetic valve ("valve-in-valve" implantation)) experimental and investigational because the effectiveness of this approach for these indications has not been established. Treatment of dysfunctional right ventricular outflow tract (RVOT) conduits whose pulmonary valve has become stenotic (mean RVOT gradient greater than or equal to 35 mm Hg) or regurgitant (moderate or more severe regurgitation), where individuals indicated for the procedure have a full circumferential RVOT conduit greater than or equal to 16 mm in diameter when originally implanted or.This Clinical Policy Bulletin addresses transcatheter pulmonary valve implantation.Īetna considers transcatheter pulmonary valve implantation using FDA-approved devices (e.g., Harmony Transcatheter Pulmonary Valve (TPV) System, Melody Transcatheter Pulmonary Valve, and Sapien S3 Valve) medically necessary for the following indications: Number: 0821 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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